Percutaneous venopulmonary artery extracorporeal membrane oxygenation for right heart failure after left ventricular assist device insertion
| Autor: | Alain Bel, Jean-Michel Grinda, Nadia Aissaoui, Christian Latremouille, Marie-Cécile Bories, Yashutosh Joshi, Jérôme Jouan |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Percutaneous medicine.medical_treatment Femoral vein 030204 cardiovascular system & hematology Pulmonary Artery 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation medicine Extracorporeal membrane oxygenation Humans Retrospective Studies Heart Failure business.industry Extracorporeal Technologies Left pulmonary artery medicine.disease Cannula Mediastinitis Surgery surgical procedures operative 030228 respiratory system Ventricular assist device Heart-Assist Devices Cardiology and Cardiovascular Medicine business Destination therapy |
| Zdroj: | Interact Cardiovasc Thorac Surg |
| ISSN: | 1569-9285 |
| Popis: | OBJECTIVES Right ventricular failure after left ventricular assist device (LVAD) insertion is associated with significant mortality and morbidity. Mechanical support options include right ventricular assist devices, venoarterial extracorporeal membrane oxygenation (ECMO) and venopulmonary artery ECMO, the latter often involving central cannulation. We sought to evaluate the feasibility and early outcomes of a truly percutaneous venopulmonary artery (pVPA) ECMO strategy, with the potential advantage of bedside removal once weaned. METHODS Data from a single tertiary centre were reviewed retrospectively from January 2014 to January 2019. During this time, 54 patients underwent LVAD insertion, with 19 requiring mechanical support for right ventricular failure. Among them, 10 patients received pVPA ECMO. Implantation of the pVPA ECMO was performed under transoesophageal echocardiography and fluoroscopy guidance, with an inflow cannula placed in the right atrium via the right femoral vein and an outflow cannula placed in the left pulmonary artery (PA) via the right internal jugular vein. RESULTS Cannula insertion was 100% successful with no need for repositioning. Eight patients (80%) were able to be successfully weaned (at the bedside); 6 were discharged from the hospital and there were no cases of early sepsis, mediastinitis or thromboembolism. At follow-up, 5 patients had received transplants (50%), with 1 on LVAD support as destination therapy (10%). Survival was 60 ± 15% and 50 ± 16% at 6 and 12 months, respectively. CONCLUSIONS pVPA ECMO is 100% technically feasible and is an efficient method for temporary right ventricular support after LVAD insertion with the advantage of simple bedside removal and avoidance of a PA graft remnant in the chest cavity. |
| Databáze: | OpenAIRE |
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